Prolonged Prophylaxis With Valganciclovir Is Cost Effective in Reducing Posttransplant Cytomegalovirus Disease Within the United States

Blumberg, Emily A.; Hauser, Ingeborg A.; Stanisic, Sanja; Mueller, E; Berenson, Kathy R.; Gahlemann, C. G.; Humar, Atul; Jardine, Alan G.

doi:10.1097/tp.0b013e3181ff500d

Cited by 28 publications

(20 citation statements)

References 39 publications

(39 reference statements)

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“…A recently published randomized trial proved the clinical superiority of 6-month valganciclovir prophylaxis compared to a 3-month course in high-risk renal transplant recipients [30]. Cost-effectiveness analyses showed the advantage of 6-month prophylaxis in quality-adjusted life years in a 5- to 10-year period using Markov model [25,31]. However, the limitation of such analyses lies in the use of clinical probabilities of graft failure and death in association with CMV disease from different studies, which may vary significantly among different transplant centers or immunosuppressive regimens.…”

Section: Discussionmentioning

confidence: 99%

Pharmacoeconomic Impact of Different Regimens to Prevent Cytomegalovirus Infection in Renal Transplant Recipients

Kielberger¹,

Bouda²,

Jindra³

et al. 2012

Kidney Blood Press Res

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Background: The aim of this study was to determine the cost impact of four different strategies for prevention of cytomegalovirus (CMV) disease after renal transplantation. Methods: Hospitalization data and medical resource utilization data were prospectively collected alongside two randomized trials. In the first trial, the patients were randomized to 3-month prophylaxis with either oral ganciclovir (1 g t.i.d., n = 36) or valacyclovir (2 g q.i.d., n = 35), and to the control group (n = 12) managed by deferred therapy. In the second trial, the patients were randomly assigned to 3-month valacyclovir prophylaxis (n = 34) or preemptive therapy with valganciclovir (900 mg b.i.d. for a minimum of 14 days, n = 36) for significant CMV DNAemia. The cost analysis involved all real costs directly related to CMV during the first year after renal transplantation. Results: The mean CMV-associated costs per patient were EUR 4,581, 2,577, 4,968, and 8,050 in patients in the ganciclovir, valacyclovir, preemptive, and deferred therapy groups, respectively (p < 0.001). Valacyclovir prophylaxis was significantly less expensive than any other regimen. The cost of one episode of CMV disease was EUR 7,510 per patient. Due to excessive incidence of CMV disease, deferred therapy was the most expensive strategy (p < 0.001). Conclusions: Valacyclovir prophylaxis is less expensive strategy compared with any other regimen.

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Section: Discussionmentioning

confidence: 99%

Pharmacoeconomic Impact of Different Regimens to Prevent Cytomegalovirus Infection in Renal Transplant Recipients

Kielberger¹,

Bouda²,

Jindra³

et al. 2012

Kidney Blood Press Res

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“…Compared to the pre-emptive strategy prophylaxis is logistically easier, with lesser monitoring cost, but higher cost of drug therapy [11]. Overall, the universal prophylaxis (especially for 200 days duration) was cost-effective when indirect benefits were also accounted for [19,20]. Problems with prophylactic strategy include frequent leucopenia, increase in late onset CMV disease, and emergence of resistant CMV.…”

Section: Cytomegalovirus Diseasementioning

confidence: 99%

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

Basu¹

2015

TOUNJ

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Abstract:Infections are the bugbear of kidney transplantation in the tropics, being responsible for majority of the deaths. Despite the several challenges posed by infections in kidney transplant recipient in the tropics, various developments have resulted in a decline in the rate of infections as well as their consequences. This review aims to be a basic overview of the common infections in KTR with an attempt to provide a unique tropical country perspective.

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“…A metaanalysis of 11 randomized trials (698 patients; median follow-up: 12 months, range: 3-22 months), with six randomized trials (302 patients) after kidney transplantation, demonstrated a beneficial effect of the prophylactic use of CMV immunoglobulin on total survival and prevention of Should not be used 1500 mg once a day, or 500 mg three times a day Should not be used 1000 mg once a day, or 500 mg twice a day [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Should not be used 500 mg once a day <10…”

Section: Antiviral Medications For Universal Prophylaxis and Preemptimentioning

confidence: 99%

“…Thus, universal prophylaxis resulted in a cost saving of $27 967 per qualityadjusted life year gained when compared with preemptive therapy. Using data from the Improved Protection Against CMV in Transplant (IMPACT) trial demonstrated that prolonged prophylaxis of 200 days with valganciclovir compared with 100 days significantly reduces the incidence of CMV in high-risk kidney transplant (D+/R−) recipients; a cost-effectiveness model was developed to evaluate prolonged prophylaxis (200 days) with valganciclovir and its long-term economic impact from the US healthcare payer perspective (16). For the first 5 years, they found that the incremental cost-effectiveness ratio of US $14 859/qualityadjusted life year suggests that 200-day valganciclovir prophylaxis is cost effective compared with the 100-day regimen, considering a threshold of US $50 000 per qualityadjusted life year.…”

Section: Universal Prophylaxis and Preemptive Therapymentioning

confidence: 99%

CMV: Prevention, Diagnosis and Therapy

Kotton

2013

American Journal of Transplantation

242

218

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Cytomegalovirus (CMV) is the most common infection after organ transplantation and has a major impact on morbidity, mortality and graft survival. Optimal prevention, diagnosis and treatment of active CMV infection enhance transplant outcomes, and are the focus of this section. Methods to prevent CMV include universal prophylaxis and preemptive therapy; each has its merits, and will be compared and contrasted. Diagnostics have improved substantially in recent years, both in type and quality, allowing for more accurate and savvy treatment; advances in diagnostics include the development of an international standard, which should allow comparison of results across different methodologies, and assays for cellular immune function against CMV. Therapy primarily involves ganciclovir, now rendered more versatile by data suggesting oral therapy with valganciclovir is not inferior to intravenous therapy with ganciclovir. Treatment of resistant virus remains problematic, but is enhanced by the availability of multiple novel therapeutic agents.

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Prolonged Prophylaxis With Valganciclovir Is Cost Effective in Reducing Posttransplant Cytomegalovirus Disease Within the United States

Abstract: Prolonged prophylaxis with valganciclovir reduces the incidence of events associated with CMV infection in high-risk kidney transplant recipients and is a cost-effective strategy in CMV disease management.

Cited by 28 publications

References 39 publications

Pharmacoeconomic Impact of Different Regimens to Prevent Cytomegalovirus Infection in Renal Transplant Recipients

Pharmacoeconomic Impact of Different Regimens to Prevent Cytomegalovirus Infection in Renal Transplant Recipients

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

CMV: Prevention, Diagnosis and Therapy

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